Lamar Alexander

Mr. ALEXANDER

Mr. ALEXANDER. Without yielding the floor, I certainly would be glad--if I may reclaim the floor. I have the floor. I will be glad to allow the Senator from California to say whatever she would like, if I can have consent to have the floor back.

Mr. ALEXANDER. I thank the chairman. I look forward to moving over there and working on the Interior appropriations bill. I think Senator McCain is here to speak about it. I was only, in an extravagant gesture of courtesy, trying to answer the question of the distinguished assistant Democratic leader from Illinois.

Mr. ALEXANDER. The Republican health care reform bill, Madam President, if I may talk about it, has been offered in a series of proposals. The proposal for a small business health insurance program is less than 1,000 pages, by several hundred pages. What I think I will do is not take so much more of the Senator's time, but I will enumerate the proposals and give him the number of pages. While he is reading our proposals, I will read his, and we will see who gets through first. Of course, we will have to wait until they come out from behind closed doors with their bill. I will get the small business proposal. I will get the proposal to end junk lawsuits against doctors. I will get the proposal to allow people to buy insurance across State lines, which will reduce the cost of insurance. I will get the proposal that would adjust tax incentives. There is a proposal that would also expand technology on which we have proposals on both sides of the aisle. So I will get five or six of the Republican proposals, most of which we hope will gain bipartisan support. I see the assistant Democratic leader every day at the beginning of the day. Maybe we can even read them together, and then whenever his bill comes out from behind closed doors and we get the House bill, we can all read that 2,000-page bill. I am going to accede to the wishes of the chairman of the Interior Appropriations Subcommittee, because I am her ranking minority member, and cease talking about the end of the era of the 1,000-page bill and let us get to Interior appropriations.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, if the Senator from Arizona has another minute, I thank him for coming to the floor because he has pointed out the value of taking a little time on these important pieces of legislation. He has suggested a way we can not only extend unemployment compensation benefits, which almost all of us want to do, but a way to pay for it in a way that creates more jobs rather than fewer. There is another example. The Senator from Rhode Island was complaining about the 82 times that the majority leader has invoked cloture, and I was saying that was nothing to brag about. We should be complaining about that, because that is 82 times he has cut us off. In general, he has allowed during this year a fair amount of amendments, a fair amount of debate. But take the health care bill for a moment. It takes a little time. Over in the House I hear they may run that through in 3 days. That is not going to happen here. When we have time to stop and think about it--the same thing happens on this floor that happened last week. We had our first vote on health care and the question was, Shall we raise the debt \1/4\ trillion dollars?, and 13 Democrats joined all Republicans and said no. We have another important vote coming up soon that might be called a procedural vote but, in fact, is a vote for or against a bill.

Mr. ALEXANDER. Of course.

Mr. ALEXANDER. If I could ask one more question of the Senator from Arizona, who is giving a lot of time to this discussion. I thought this health care debate was supposed to be about reducing costs--the cost to the government and the cost to people buying premiums. Whatever happened to that goal?

Mr. ALEXANDER. We are here every day. We want to do what the Senator from Arizona said. We want to read the bill and we want to know what it costs because when we hear about it--and the Senator from Arizona was a part of the Finance Committee that developed one bill; I was a part of the HELP Committee that developed another bill. What we hear is that instead of lowering premiums, which is the idea for 250 million Americans, it will probably raise premiums; that it will raise taxes; that it will cut Medicare by $450 billion. Now we learn from the majority leader this week that there will be a new government-run insurance program. We are going to put the government in the insurance business with a ``State opt-out,'' whatever that might mean. I am a former Governor. I am wondering, Does that mean we can opt out of the taxes as well as the benefits? So the Senator from Arizona is right. We are here. We are ready to go to work. We are anxious to read the bill, but it is being written behind closed doors.

Mr. ALEXANDER. Mr. President, I enjoyed the comments of the distinguished Senator from Rhode Island. He is one of the most thoughtful and intelligent Members of the Senate. I always enjoy listening to him. But I have a different characterization of what we are doing in the Senate. He pointed out that the majority leader believed it was necessary to cut off debate 82 times; that was a record. I do not believe I would be bragging about that. This is the Senate. What that means is the majority leader has said to the minority: Be quiet. Don't debate. We don't want your amendments--82 times. The House of Representatives is the place where we have the train that runs through according to the majority. That is not the Senate. Senator Byrd, the senior Democrat, the senior Senator, has written four big volumes about the history of this body and what is unique about the Senate. Our Founders said: We will have one popular body where there is one man one vote, one woman one vote, and whoever has the majority the train runs through. So whatever Speaker Pelosi wants, Speaker Pelosi gets. That was the view of the Founders more than two centuries ago. But we are going to have a little bit different Senate. Do you know what the idea of the Founders was, the Founders, whom we revere and admire? Unlimited debate. Unlimited amendment. That is the Senate. That is the only reason we have it. There is no need for the Senate if we do not have that. When Alexis de Tocqueville, the young Frenchman, came to this country in the 1830s and wandered around our Nation and wrote that perceptive book, ``Democracy in America,'' which every serious student of the American Constitution in our country discovers, he saw one thing he worried most about in the new American democracy, and it was, in his words, the tyranny of the majority. He said the Senate was the one institution which helped work against the tyranny of the majority. So this is the body that protects the minority view. It does slow things down. In the case we are talking about, unemployment compensation, we have already voted to limit debate on unemployment compensation. That is what we are talking about today. I see the Republican whip on the Senate floor. As I recall, the vote to limit debate on unemployment compensation was overwhelmingly bipartisan, was it not?

Mr. ALEXANDER. The Senator from Arizona is correct. And as a member of the Finance Committee, he has once again come up with a very good suggestion. He understands better than some appear to that if we add taxes to payrolls, it makes it more likely that payrolls will be smaller or there will be fewer jobs. So if we can find a way to pay for unemployment compensation that does not add to the debt and does not add to payroll taxes, that is worth taking a little time to do.

Mr. ALEXANDER. Mr. President, I think the Senator is exactly right, and we on the Republican side--and I believe some Democrats do as well--have some proposals about how to restart housing. We would like to deal with that on this issue as well. But the Senator is exactly correct. The No. 1 issue for most Americans is what to do about jobs. Unemployment is about at the rate of 10 percent.

Mr. ALEXANDER. I believe the answer is no. If I am not mistaken--if I am not mistaken--I say to my friend from Arizona, the Democratic side has a nongermane amendment they would like the Senate to bring up, and I believe the Republican side has a nongermane amendment we would like to bring up. They are saying: Because we are in the majority, we are going to run over you. That is the tyranny of the majority. That is what Alexis de Tocqueville warned against, and we are saying: No, you are not. We are elected from Arizona and Tennessee to represent our constituents. If you are going to run over us, we might as well go home.

Mr. ALEXANDER. Mr. President, I ask unanimous consent that the Senator from Arizona and I be allowed to engage in a colloquy on this subject.

Mr. ALEXANDER. I thank the Senator from Arizona. All of this got started because the Senator from Rhode Island had complained that the Democratic leader had to cut off debate 32 times, and my response was that was nothing to brag about; that is what the Senate is for. That is how the Founders created it. I appreciate the Senator from Arizona pointing out that in the case of unemployment compensation, we all want to extend the benefits. We think we may have a way to do that in a way that creates more jobs rather than taxes on jobs. In the case of health care, yes, we want to go slow enough to be able to do two things: Read the bill, know what it costs, because we want to make sure that if we pass a health care bill, we are not the Congress of higher premiums, higher taxes, Medicare cuts, and adding to the debt. I think the American people want to make sure we do that as well. So I am grateful that we have the Senate. We are always a little more grateful for those rules when we are in the minority, because they protect our rights to represent the people who elect us and to ask us to offer amendments. But the American people have been served very well by a Senate that has different rules and procedures. Student Loans I wish to say a word about a subject which has nothing to do with health care and nothing to do with climate change, which is the other subject I have been in hearings on today, but it is a subject that will affect millions of families in America, and that is the question of going to college and student loans. All of us can imagine the anxious moments in our family lives--and there are a number of them, including when a baby is born or when the daughter goes out on her first date; when someone is sick; when a child goes off to college. But one of the most anxious moments comes just after the first of every year when, in millions of homes across America, students and their parents wait to see if they have been admitted to college and to which college. The next anxiety comes when they turn to the various options they have to see whether they can afford to go to that college. Fortunately, in America we have the best system of higher education. We not only have the best colleges; we have almost all of the best colleges. We have 6,000 autonomous institutions of one kind or another--public, private, religious, secular, profit, for-profit--among which students may choose. Second, even though prices have been going up, we have bent over backward in this country to try to make it possible for the largest number of Americans to attend college. Seventy-seven percent of Americans who attend college--nearly 20 million--have a Federal grant or Federal loan to help them do that. So just after January--and I want to paint this picture--in homes across America, we have millions of students, millions of families who are waiting for their college admissions and then will turn to the question of: Can I get some help paying the bills. Specifically, we have 14 million--if next year is anything like last year and the year before--14 million of those students who will be going to college on 35 campuses who will be borrowing $60 million through the Federal Family Education Loan Program--what we call the traditional student loan program. We have two types of loan programs. We basically have one through two thousand lenders, profit and nonprofit, across the country. For example, we have an organization called Edsouth in Tennessee that is nonprofit. It offers a variety of student loan options to Tennessee students. It has five regional outreach counselors to provide college and career planning, financial aid training, college admissions assistance, and financial literacy. It makes 443 presentations at Tennessee schools through college fairs, guidance visits, and presentations. It works with 12,000 Tennessee students to improve their understanding of college admissions and the financial aid process. Last year, Edsouth provided training to over 1,000 school counselors and distributed 1.5 million financial aid brochures. The various lending institutions--profit and not-for-profit--are usually in these communities and easy for these 14 million students to get to. There is another group of students--about a fourth to a third in total--who choose to go another route in getting a student loan, called direct lending. They borrow directly from the government. This was set up as a pilot program when I was the Secretary of Education in the early 1990s. It was set up to see whether the traditional student loan program, which is through your local bank or nonprofit, was working right, and what was best for students. Students and colleges have voted over the years with their practices. For example, in Tennessee, most Tennessee campuses and most Tennessee students choose the traditional student loan program. At the University of Tennessee, where I was once president, in Knoxville, there are 30,000 students, and 11,000 have a Federal loan. They get that through the traditional loan program, not the government direct loan program. At Maryville College, in my hometown, where my parents went, 824 of 1,100 students have a Federal loan. They get that through the traditional loan program. At Carson-Newman, at Jefferson City, where I am going Friday to help inaugurate a new president, with 2,000 total students, 1,259 have a Federal loan. I can go through each of the institutions in our State. You can see the number of families that any change in the student loan program affects, and if you add the anxiety that comes with receiving your college admission and worrying about whether you can pay the bill--you can see the problem that causes. The reason I came to the floor is that for those 14 million students--more or less--who, in January, February, and March, would be expected to turn to the traditional student loan program, we are about to have a 14-million car pile-up on the interstate highways of American education because of action taken by the U.S. Department of Education. The Secretary of Education--a man I greatly admire--has sent a letter to the various schools--3,500 or so campuses--that now use the traditional loan program, and he said you better get ready for the government-run program, and you need to do it because I may not be able to continue to offer the traditional loans. That is a big mistake. I want to point out the reasons. First, there is not time to switch, even according to a New York Times article. I ask unanimous consent to have printed in the Record the Secretary's letter to the campuses and the New York Times article.

Mr. ALEXANDER. The Secretary's assistant says it takes at least 3, 4 months for colleges to switch their computers around, so instead of offering aid through a traditional program, they offer it through the government direct loan program. There will be a lot of confusion in January, February, March and April. There is not time to switch. Second, the Secretary has gotten ahead of himself. The President has proposed a Washington takeover of the student loan program, but this Washington takeover requires congressional approval. We have more than one branch of government in this town. I know the House of Representatives has passed the President's request, but there's one more--the United States Senate has not approved the President's request, and I hope it does not. It is a bad idea. So I hope the Secretary will write another letter and say I have changed my mind, given the lateness of the situation in the year--we are almost to November--and the fact that it takes up to 4 months for any college to make a changeover, and because most students will begin to receive their college admissions in January and February, et cetera. I hope the Secretary will say I am going to take a little different approach and work with Congress, recognizing that the Congress has to approve this proposal as well. First, we are going to extend the law that was passed a couple of years ago, which provides emergency financing to back up all of the traditional student loans that are made. That has worked out very well. The institutions participating have paid large fees to the government and students have gotten their loans. We can extend that another year. It doesn't expire until June. Second, the Secretary might say that I am going to work with Congress to make some changes in the existing student loan program to make it right. We can talk about ways to do that. Third, I hope he will say I am going to work with Congress to set up a transition time that is appropriate for any colleges that want to move from the traditional student loan program to the government-run direct loan program. When time comes for us to debate and act on whether there should be a Washington takeover of student loans, I am going to say, no, there should not be. I have a little history here. I think the American people have had enough Washington takeovers--banks, insurance companies, General Motors, et cetera. The President can argue that he inherited a lot of that. But this takeover is truly voluntary. Nobody is asking the Secretary of Education to become the banker of the year. I would rather he become the Secretary of the year. I think he could do that. I think he is an outstanding Secretary, one of the best appointees--maybe the best--of the new President. The Presiding Officer is from Illinois, and he knows Arne Duncan very well. I would like to see him reward teachers and setting higher standards, instead of making 20 million student loans every year. I want him to be the educator of the year, not the banker of the year. Deep in his heart, maybe he wishes that as well. The administration has told us about this latest Washington takeover that is starting next year, and that the nearly 20 million students who want government-run direct loans should all line up at offices designated by the U.S. Department of Education. This will, the argument goes, save taxpayers $87 billion in subsidies that now go to greedy banks. In anticipation, Members of Congress--we--have already spent the $87 billion for more Pell grants, community college improvements, and other new programs. That sounds very good. Banks are punished, students are helped and, most important, Congressmen look real good. Here is what they have not told you. Your friendly government, for all this, will overcharge you, the student--and use the profit to pay for the new programs that make the Congressmen look good. Yes, those of you who borrow student loans--the 20 million--the Education Department is going to borrow the money at 2.8 percent from the Treasury and loan it to the students at 6.8 percent, and spend the difference on administrative costs and new government programs. That means a student will spend a few more months or years working to pay off the student loan in order to help pay for someone else's education and help the Congressmen's reelection. There are a few other things the government ought to tell you. The $87 billion isn't real. According to a letter in July from the nonpartisan CBO to New Hampshire Senator Gregg, the savings are closer to $47 billion. If we use the same cost scoring analysis that the CBO required when we passed the Troubled Assets Relief Program, or TARP, the savings I think are less than that, since the government assumes it can make 19 million loans each year for what it now costs to make 4 million loans. Finally, the government needs to disclose to these 20 million students who are thinking about going to college next year that getting your loan will become about as enjoyable as waiting in line for your driver's license. Today there are 2,000 lenders--banks and nonprofit institutions--competing to offer government-backed students loans at 4,400 campuses. I mentioned earlier the kinds of services they provide. That is all about to change. There will only be one student loan banker under this proposal, the U.S. Secretary of Education. I wouldn't have wanted that job when I was in that position, and I cannot imagine any Education Secretary wanting that job. There will be no competition to make it easier to get your loan. Imagine 20 million students and families trying to call a Federal call center to make their arrangements to go to college. It is true that during the last 20 years subsidies the government paid to lenders to make student loans were excessive. Congress took steps to correct that 2 years ago. If there is still $87 billion, or $47 billion, in real savings, then the subsidies are too high and we should lower them and give the savings to students, not trick students by overcharging them to pay for more government programs and run up the Federal debt in the process. Seven-eighths of the students who applied for Federal aid using the Free Application for Federal Student Aid had an average loan of about $25,000. Assuming a standard 10-year repayment at 6.8 percent, which is the rate set by Congress, these students would pay roughly $9,400 in interest. But we could use the savings to reduce the interest rate by as much as 1.5 percent--down to 5.3--and those students would pay only $7,100 in interest, a savings of $2,200. If this Washington takeover goes through, every one of the 19 million-plus student loans made in 2010 should carry this warning label: Beware, your Federal Government is overcharging you so your Congressman can take credit for starting a new government program. Enjoy the extra hours you work to pay off your student loan. Mr. President, I see my colleague from South Dakota on the floor and my colleague from Nebraska, so I will conclude. The Secretary of Education should change his mind, withdraw his letter, and work with Congress to extend the temporary law and improve the student loan program and reassure students that they don't have to be anxious about standing in line in January for a loan. I yield the floor.

Mr. ALEXANDER

Mr. ALEXANDER. I thank the distinguished assistant Democratic leader for raising the point. It is a point I would be delighted to address. I voted against that proposal. That proposal was a backdoor effort in what was a so-called jobs bill to spend $85 billion over 2 years for Medicaid. That is one reason why we have 10 percent unemployment today, because the money that was supposed to be for the stimulus was borrowed from the biggest deficits we have ever run up in history and spent on something other than jobs. What it also did was it unrealistically lifted the level of Medicaid spending in Tennessee and every other State, forcing an expansion of that program, which I will go on to show in a minute is nearly cruel to the people who are dumped into the program because doctors and hospitals will not serve them. So I was glad to vote against that program. I was sorry it passed because it borrowed money we don't have to spend on programs that didn't create jobs, and it artificially lifted and expanded Medicaid, which is already bankrupting the States. Medicaid expansion is not real health care reform. One reason is because 40 percent--according to a 2002 Medicare Payment Advisory Committee survey--of the physicians restrict access for Medicaid patients; meaning they will not take new Medicaid patients because reimbursement rates are so low. Only about half of U.S. physicians accept new Medicaid patients compared with more than 70 percent who accept new Medicare--those are the seniors--patients. According to a 2002 study in the Journal of American Academy of Pediatrics, the national rate for pediatricians who accept all Medicaid patients was 55 percent. In Tennessee, it was lower than that. Why is that? It is because reimbursement rates are so low. Today, doctors who see patients who are on Medicare get paid about 80 percent of what private insurers pay. Doctors who see patients who are on Medicaid get paid about 61 or 62 percent of what private insurers pay. For doctors who see children, it is sometimes lower than that. So doctors don't see those patients. What is going to happen if we dump 14 more million low- income Americans into a system such as that? Those patients--especially those children--are going to have a harder time finding doctors and hospitals to take care of them. It would be akin to giving somebody a ticket and a pat on the back to a bus line that only operated 50 percent of the time. Further, the quality of care for Medicaid patients is significantly lower than those with private insurance and even those with no insurance. According to a survey by the National Hospital Ambulatory Medical Care, Medicaid patients visit the emergency room at nearly twice the rate of uninsured patients. A 2007 study by the Journal of the American Medical Association found that patients enrolled in Medicaid were less likely to achieve good blood pressure control, receive breast cancer screening, have timely prenatal care than similar parents in private plans, and they had lower survival rates. I mentioned this a little earlier. According to the Government Accountability Office, Medicaid--the program we are seeking to expand, the government-run insurance program that sounds so good, the so-called largest public option plan we have to date, the plan where about half the doctors will not take new patients who are on the program--had $32.7 billion in improper payments in 2007 alone; 10 percent of the program's total spending is wasted. So as we consider a so-called public option, I hope we will look at the public option we already have--called Medicaid--one which already has an opt-out provision for States, one which already has 60 million low-income Americans in it, one into which we plan to put 14 million more Americans, so that 50 percent of the doctors will say to new patients: I can't see you because the reimbursement rates are so low. Medicaid is the public option we have right now. States could opt out of it, but quality is low, fraud is high, costs are up, and Governors of States on both sides of the aisle are saying: We are headed toward bankruptcy at the present rate. If you are sending us more bills, if you want to expand it, pay for it. And doctors are turning away patients. The American people deserve better than that. I am a cosponsor of a bipartisan bill that would actually reduce the number of patients on Medicaid. It is called the Wyden-Bennett bill. It adds no cost to the government. That bill is not being seriously considered. The other approach that we Republicans believe we should take is focusing on reducing costs to the government, focus on reducing the cost of premiums; take four or five steps in the right direction and expand services to uninsured patients as we go. One way to do that, of course, would be the Small Business Health Insurance bill, which has broad support in both Houses, which would permit small businesses to come together and pool their resources. The estimates are that at least 1 million more Americans would be covered by employer insurance if that were to happen. Some estimates say many more millions. But especially on a day when the press has it rumored that the majority leader may offer a new government-run insurance program with the States having the opportunity to opt out, I hope Americans will look carefully at the current government-run insurance program which States have the option to opt out of, but none do, and note that it has 60 million Americans--it is soon to have 74 million; half the doctors won't see new patients because of reimbursement rates; and $1 out of $10 is wasted. It is not a solution to health care and neither is a new public option. I yield the floor and thank the Senator from Illinois for his question.

Mr. ALEXANDER. Mr. President, I will let the majority leader make his own announcements, but there are a lot of discussions in the news media today that in a short period of time he intends to hold a press conference announcing that he will push ahead with the so-called public option in the health care legislation--one that currently includes an opt-out provision for States. I don't know whether he intends to do that or whether he doesn't. He is entitled to make his own announcement, as I said. But it provides a good opportunity to talk about what we mean by a public option in health care, or a government-run health care plan, putting government in the health care business, and how it already works, and how it might work if States were allowed to opt out. The reason it is easy to talk about this is--and the former Governor of Virginia, who is presiding, knows this as well as I do, and maybe better because he has been Governor more recently--we already have in existence in the United States today a public option health insurance program which States may opt out of. It is called Medicaid. Medicaid is the largest government-run program we have in health care--even larger than Medicare. Medicare, for older people, has about 40 million persons who depend on it. Medicaid, which sometimes offers confusion, is a different program. It is a program for low-income Americans. It started out for women and children, but it gradually expanded, and today it has nearly 60 million Americans who depend on it. The health care legislation, which is coming forward in the Baucus bill out of the Finance Committee and the HELP Committee, on which I serve, and the bills in the House of Representatives--all those pieces of legislation would expand the Medicaid Program--not Medicare for seniors but the Medicaid Program-- and send part of the bill for that expansion to the State. So let's talk about that a little bit, particularly if it is true that the majority leader is about to propose that we have yet another government-run insurance program, giving the States the right to opt out, which sounds pretty good. Let's see how this one works that we already have, especially since the health reform bill that is headed our way would expand Medicaid, and according to the Congressional Budget Office, cost States an additional $33 billion in State dollars and add 14 million people to Medicaid. I guess the first thing to know about a government-run health insurance program which States can opt out of is that they can't. I mean, in the real world, they can't. Not one has. Every State in America has Medicaid. The Federal Government pays roughly 60 percent of it; State taxpayers pay the rest. Most of the rules are written in Washington. States can ask for exemptions from the rules, but it is a long and burdensome process. It is not realistic to say the States can opt out of the Medicaid Program for low-income Americans. I suppose it might not be realistic, therefore, to say the States would be able to opt out of a new government-run program--a government-run, public- option program--that may be suggested by the majority leader. We should wait and see what he proposes, but I think we would be wise to pay attention to the fact that in the current government-run program we have today, no State finds it realistic to opt out. Expanding Medicaid, which is what the health reform bill coming toward us on the floor proposes to do, is not just an expensive item for the Federal Government and for States, it is a terrible vehicle for health care reform. The current Governor of Tennessee--Governor Bredesen--a Democrat--has said putting more low-income Americans into Medicaid is not health care reform. Why would he say that? Because it makes it worse for those Americans as they seek to get access to care from doctors and hospitals and as they seek to get good, quality care. Plus, the program is riddled with so much fraud and abuse that, according to the Congressional Budget Office, $1 out of every $10 is stolen or wasted. Most Governors who have struggled with Medicaid--and I am one of them--agree that its expansion is a bad idea. They unanimously have said to us in Congress that if you in Washington want to expand Medicaid, then you in Washington need to pay for Medicaid. That is the theory of no more unfunded mandates that every Governor whom I know about has agreed with for years. In fact, there was nothing that used to make me angrier as a Governor than for a distinguished politician in Washington to stand, make a speech, come up with a good idea, hold a press conference declaring a problem solved, and then send the bill to the States. So what does the Governor and the legislature and the mayor and the city council have to do? They have to cut services, they have to raise taxes, they have to run up tuition, they have to cut out some classes because somebody in Washington thought it was a good idea to do this. Well, that is what we are proposing to do with Medicaid. We are saying to the States: We have a great idea. We want to expand Medicaid by dumping another 14 million low-income Americans into this program, but congratulations, we are going to send you the bill to help pay for it. The Washington Post quoted my home State Governor, Governor Bredesen, to whom I just referred, this way in regard to health care reform: I can't think of a worse time for this bill to be coming. I would love to see it but nobody is going to put their State into bankruptcy or their education system into the tank for it. One of the most painful letters I have ever read was from Governor Bredesen, which he sent on October 5, when he wrote about Tennessee's fiscal situation--similar to the condition in most States. He said: By 2013 we expect to return to our 2008 levels of revenue and will have already cut programs dramatically--over $1 billion. At that point we will have to start digging out--we will not have given raises to State employees or teachers for 5 years. Our pension plans will need shoring up. Our rainy day fund will be depleted . . . we will not have made any substantial investments for years . . . There will be major cuts to areas such as children's services. On top of these, there are the usual obligations that need to be met-- Medicaid, for example, will continue to grow at rates in excess of the economy and our tax revenues. Our idea of health care reform is to expand Medicaid and send Governor Bredesen a bill for $735 million over the next 5 years, which we can't afford. The other legislation, from the HELP Committee, would cost the States even more. According to an actuarial report from the Centers for Medicare and Medicaid Services, Medicaid represented 40 percent of the Federal Government's cost expenditures for health care; 41 percent of State health care costs. It is the largest source of general revenue- based spending in health services--larger than Medicare. I can vividly remember, 25 years ago, 30 years ago, as Governor, every time I made up a budget, I would start with roads. That comes from the gas tax. I would go to prisons. The court said to fund that. I would go to K-12 grades. Our Presiding Officer, the former Governor of Virginia, has had this experience. That is pretty much a set thing. Then you get down to the end and what are you choosing between? You are choosing between higher education--the University of Tennessee or the University of Virginia--and Medicaid. What is happening? Medicaid is going up like a rocket and State spending for higher education is flat. Our great higher educations systems across this country are under great stresses because of poor State funding because we have allowed Medicaid to grow out of control. Not only do we do that, we are now about to expand it--about to expand it and send more of the bill to the States. The Governors are saying: Don't do that. Their revenues are down 17, 18, 20, 35 percent in some States. If you are going to pass it, they say: Pay for it. That is a question Governors should have a chance to ask and get an answer to. According to the Texas Medicaid office, the current proposal to expand Medicaid will cost the State $20 billion over the next 10 years. We are passing it, they are paying for that much of it. According to the South Carolina Governor's office, $1.1 billion over 10 years. Governor Schwarzenegger has said for California it could be as high as $8 billion a year. A New York Times article, in late September, said this: The recession is driving up enrollment in Medicaid at higher than expected rates, threatening gargantuan State budget gaps even as Congress and the White House seek to expand the government health insurance program for the poor and disabled . . . The New York Times went on to say: . . . enrollment in state Medicaid programs grew by an average of 5.4 percent in the previous fiscal year, the highest rate in 6 years. . . . In eight states, the growth exceeded 10 percent. So States have headlines such as this: ``State Looks at $1 Billion in Cuts.'' Their Medicaid is already growing at a rate faster than they can pay for, and we are sending them more bills than they can pay for.

Mr. ALEXANDER. I will be happy to yield.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. ALEXANDER. Mr. President, is now the time to begin the Republican part of morning business?

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, first impressions are important. Depending on one's age, we remember different things. When I was a young teenager, the first college football game was broadcast on a television network. It was Tennessee versus Alabama with Lindsey Nelson, who had gone to Tennessee, and Mel Allen, who had gone to the University of Alabama, as the announcers. There have been a lot of good football games since that time, but everyone remembers the first broadcast. I can remember the first one-hour evening news program. I think it was ``Huntley-Brinkley'' on NBC. There have been a lot of distinguished newscasters before and since, but that was the first one-hour news program with two anchors. I can remember watching basketball games and getting a glimpse of a coach and forming an impression of the whole university from a short glimpse. An experience we've all had is meeting someone for the first time and getting a first impression that is usually a fairly accurate impression of that person. It usually lasts a long time, and it is hard to get over a first impression. Yesterday was the first vote on health care reform. I think the American people got a very strong first impression from that vote. What the majority leader, the Democratic leader, sought to do was add $\1/4\ trillion to the national debt on the first health care vote. The Senate said: No, we are not going to do that, even for a worthy cause, which in this case was fixing the doctors reimbursement procedure; which the Senator from Maryland just discussed and which we all agree needs to be attended to. But the Senate--all 40 Republicans, and 13 Democrats--said no, we are not going to start by adding $\1/4\ trillion to the national debt on the first vote of health care reform. Especially not at a time when we just finished a year which added $1.4 trillion to the national debt, three times as much as the year before, and as much as we added to the entire national debt in the first 200 years of the Republic. People are very worried about the growth of the debt, and that was reflected yesterday in the first vote on health care reform. I think that reminds us of the importance of reading the bill and knowing what it costs. That also is a bipartisan approach here. All the Republicans have said we want to be able to read the bill and know what it costs before we start voting. And even though Senator Bunning's amendment, which would have allowed this, was voted down in the Finance Committee by Democrats, eight Democratic Senators wrote the Democratic leader and said: We agree; put the bill on the Internet, the complete text, for 72 hours and let's have a formal calculation of exactly what it costs before our first vote. We had a first vote yesterday, even before we have a complete bill. Because we had a chance to read this one provision and time to think about it, we came to the right conclusion and voted it down. In the next several months of discussion there will be many other issues such as this about how we reform health care. My view--and I think the view of most Republicans and I believe most Americans--is to reduce costs. We have to reduce the cost of health care to our government, otherwise it is going to go broke. The President hosted a summit on entitlement spending early in the year which I was invited to it. I appreciated receiving the invitation and I attended the summit. Everybody there said if we do not control health care spending, we are going to go broke as a government. Then millions of Americans are saying: I cannot afford my own health care; 250 million of us have a health care premium we pay or someone helps us pay or some combination, and it is too expensive for individuals and for small businesses. So our goal is to reduce the cost of health care to government and reduce the cost of health care to Americans. Yet our first vote yesterday was to increase the debt, and we said no. Let's read this bill as it comes to us. Right now it is being written behind closed doors in the majority leader's office. With such a controversial issue I am not sure that is the best way to go about writing this bill. Usually it helps to have bipartisan support in the Congress, even if you have big majorities, so that you can get broad bipartisan support in the country any time you have a complex issue. When I was a young Senate aide in 1968, we had a very controversial issue before the Senate called the civil rights bill. Lyndon Johnson was President of the United States, and Everett Dirksen was the Republican leader sitting over where Mitch McConnell sits today. The Democratic majorities were bigger than they are today. President Johnson did not have the Democratic leader write the civil rights bill in a closed room in the Democratic leader's office. What did he do instead? He was very wise. He had it written in the Republican leader's office. So in Senator Everett Dirksen's office for several weeks in 1968, I recall, the bill was written in the full light of day, with Senators, staff members, and hangers-on going in and out. In the end, the bill-- more difficult than this health care bill--passed. Senator Dirksen, the Republican leader, got some of the credit. He deserved it. President Johnson got what he wanted. And the country supported it because it saw, looking at Washington, DC, a broad level of support and they felt better about that. I don't think people are going to feel as good about a bill that restructures one-sixth of our economy, that affects every single American's health, and the health care bill is being written behind closed doors, in the Democratic leader's office. We will see. But at least whatever emerges, we want to read the bill. We want the American people to be able to read the bill. And we want to know exactly what it costs before we go ahead. For example, what is it going to do to Medicare? The Republican leader has talked about that issue. If the concept paper is any indication we know what it is going to do to Medicare. It is going to cut Medicare by $\1/2\ trillion to pay for a new entitlement program. Some of my friends on the other side say: You are scaring seniors when you say that. It may be scaring seniors, but it is the truth. This bill, when implemented, is going to cost $1.8 trillion and $\1/2\ trillion is going to come from Medicare cuts. We are going to be cutting grandma's Medicare to spend on somebody other than grandma--a new entitlement program. We are doing that at a time when the Medicare Program, the program that serves more than 40 million older Americans, is going broke. We need to be careful in the Senate not to overstate issues. So let's not take my word for it. The Medicare trustees say that the Medicare Program, upon which more than 40 million seniors rely, is going to run out of money between 2015 and 2017. That is not too far away. The Medicare trustees--it is their job to watch out for these things--said: We need timely and effective action to address Medicare financial challenges. I think what they are saying to us is if you are going to cut grandma's Medicare, you ought to at least spend it on grandma instead of spending it on somebody else. That is basically what we are doing. We are cutting Medicare $500 billion, and instead of spending it to strengthen the Medicare Program, the proposal is to spend it to create a new entitlement program. What are the cuts? Nearly $140 billion in Medicare Advantage; $150 billion in cuts for hospitals that care for seniors; $40 billion for home health agencies; and $8 billion from hospices. The President said that people who are currently signed up for Medicare Advantage are going to have Medicare at the same level of benefits. That is why we need to read the bill and know what it costs because something has been lost in translation between what the President said and what appears to actually be in the bill. The Director of the Congressional Budget Office, the nonpartisan Congressional Budget Office, said in testimony that fully half of the benefits currently provided to seniors under Medicare Advantage would disappear in the Baucus proposal. The same Baucus proposal which is being amended and written and merged with other bills behind closed doors in the Democratic leader's office. The head of the Congressional Budget Office said the changes would reduce extra benefits such as dental, vision, hearing coverage, that would be available to beneficiaries. Humana advised its customers who are Medicare Advantage beneficiaries that their benefits would be cut, causing the Obama administration to put a gag order on this large health care organization. I made a little speech on the floor yesterday talking about the dangers of developing an enemies list, of boycotting television networks, of calling out Senators with whom you disagree, taking the names of bondholders who do not go along with the General Motors or Chrysler bailout, threatening an insurance company for switching from supporting your proposal to opposing your proposal or a large health care company that tells its customers the truth--your Medicare Advantage is going to be cut. Another reason to read the bill is the provision that will make additional cuts to Medicare above and beyond the $500 billion that is specified. At least that is the assumption of the Congressional Budget Office when it looked over the bill and said that it was in balance, which it has turned out not to be. The Congressional Budget Office assumed that a Medicare commission would make even more Medicare cuts. Those do not seem to be realistic assumptions. We have had a provision in law since 2003 that would provide an automatic mechanism for making Medicare cuts. Nobody has ever wanted to use it. We saw what happened yesterday, recognizing that it was unrealistic to expect that doctors would take a 21-percent cut in their pay in a year. The Democratic leader tried to borrow $\1/4\ trillion to try to take care of that problem. If we read the bill and now what it costs we find out that either doctors are going to pay for a big part of this new Medicare Program or seniors are going to pay for a big part of it or our grandchildren are going to pay for a big part of it by increasing the debt. The Washington Post said this was a shell game. I think the lesson here is first impressions count. We got a good first impression yesterday of the direction of this health care bill. The proposal was: Let's borrow $\1/4\ trillion, and the Senate, in a bipartisan way, said: We are not going to do that, no. That was the correct vote. Now we see another reason to read the bill is because we want to make sure we know what it does to Medicare. What we have seen so far is that it will cut grandma's Medicare by $\1/2\ trillion, not to spend on grandma but to spend on some somebody else, even though the Medicare Program, its trustees say, will go broke in the year 2015 to the year 2017. That is one more good reason not just to read the bill but to start over in this health care reform. We have been saying on the Republican side for months that we should not be trying to do this comprehensive, full-of-surprises, trillion- dollar health care reform, that restructures one-sixth of our economy, in the middle of the greatest recession we have had since the 1930s. We should focus instead on reducing the costs of health care to the government and to Americans who pay for premiums, and go step by step to re-earn the trust of the American people to reduce costs. We suggested how to do that. We would start by allowing small businesses to come together, pool their resources, and offer insurance to their employees. It has been estimated that would produce at least coverage for 1 million more Americans and probably many million more Americans. Second, we have suggested saving money by reducing the number of junk lawsuits against doctors which drive up the cost of health care. Third, we have suggested allowing insurance to be sold across State lines. That creates more competition that should reduce costs. We have suggested creating health insurance exchanges--many of our Democratic friends agree with that--to make it easier to shop for health care. We have suggested enrolling individuals in existing programs. There are up to 11 million people who are already eligible for programs that we now have, and that is one way to add people without increasing cost in a huge way, or creating a great new program. We have suggested incentivizing health care technology, changing tax incentives, and expanding health savings accounts. These are steps we can take to reduce costs. It appears many of the American people agree with that Republican strategy. A new Gallup poll out yesterday said that 58 percent of Americans would generally prefer to see Congress deal with health care reform on a gradual basis--over several years--rather than to try to pass a comprehensive health care reform bill this year. So first impressions count. The health care debate was defined yesterday by the attempt to borrow $\1/4\ trillion to add to the debt. I am glad it failed. The health care debate, as the President himself said, is actually a proxy for a larger debate about the role of our Federal Government in American life. Increasingly, Americans are skeptical of this comprehensive trillion-dollar-plus, full-of-surprises proposal that is being written in the back room approach. Instead they hope we will focus clearly on reducing the cost of health care premiums, reducing the cost to our government, and then going step by step in the right direction to make health care affordable for all Americans. I thank the Chair, and I yield the floor.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, in 1969 and during the first half of 1970, I was a wet-behind-the-ears, 29-year-old staff aide in the West Wing of the Nixon White House. I was working for the wisest man in that White House whose name was Bryce Harlow. He was a friend of President Johnson, as well as the favorite staff member of President Eisenhower and President Nixon's first appointee. Based upon that experience and my 40 years since then in and out of public life, I want to make what I hope will be taken as a friendly suggestion to President Obama and his White House, and it is this: Don't create an enemies list. As I was leaving the White House in 1970, Mr. Harlow was heading out on the campaign plane with Vice President Spiro Agnew, whose job was to vilify Democrats and to help elect Republicans. The Vice President had the help of talented young speechwriters, the late Bill Safire and Pat Buchanan. In Memphis, he called Albert Gore, Sr., the ``southern regional chairman of the eastern liberal establishment,'' and then the Vice President labeled the increasingly negative news media as ``nattering nabobs of negativism.'' These phrases have become part of our political lore. They began playfully enough, in the back and forth of political election combat. But after I had come home to Tennessee, they escalated into something more. They eventually emerged into the Nixon's enemies list. In 1971, Chuck Colson, who was then a member of President Nixon's staff and today is admired for his decades of selfless work in prison reform, presented to John Dean, the White House Counsel, a list of what he called ``persons known to be active in their opposition to our administration.'' Mr. Dean said he thought the administration should ``maximize our incumbency . . . [or] to put it more bluntly''--and I am using his quotes--``use the available Federal machinery to screw our political enemies.'' On Colson's list of 20 people were CBS correspondent Dan Schorr, Washington Star columnist Mary McGrory, Leonard Woodcock, the head of the United Auto Workers, John Conyers, a Democratic Congressman from Michigan, Edwin Guthman, managing editor of the Los Angeles Times, and several prominent businessmen, such as Howard Stein of the Dreyfus Corporation, Arnold Picker, vice president of United Artists. The New York Times and the Washington Post were made out to be enemies of the Republic. Make no mistake, politics was not such a gentlemanly affair in those days either. After Barry Goldwater won the Presidential nomination in 1964, Daniel Schorr had told CBS viewers that Goldwater had ``travel[led] to Germany to join up with the right wing there'' and ``visit[ed] Hitler's old stomping ground.'' Schorr later corrected that on the air. What was different about Colson and Dean's effort, though, was the open declaration of war upon anyone who seemed to disagree with administration policies. Colson later expanded his list to include hundreds of people, including Joe Namath, John Lennon, Carol Channing, Gregory Peck, the St. Louis Post-Dispatch, Congressional Black Caucus, Alabama Governor George Wallace. All this came out during the Watergate hearings. You could see an administration spiraling downwards, and, of course, we all know where that led. The only reason I mention this is because I have an uneasy feeling only 10 months into this new administration that we are beginning to see the symptoms of this same kind of animus developing in the Obama administration. According to Politico, the White House plans to ``neuter the United States Chamber of Commerce,'' an organization with members in almost every major community in America. The chamber had supported the President's stimulus package and defended some of his early appointments, but has problems with his health care and climate change proposals. The Department of Health and Human Services imposed a gag order on a large health care company, Humana, that had warned its Medicare Advantage customers that their benefits might be reduced in Democratic health care proposals--a piece of information that is perfectly true. This gag order was lifted only after the Republican leader, Senator McConnell of Kentucky, said he would block any future nominees to the Department until the matter was righted. The White House communications director recently announced that the administration would treat a major television network, FOX News, as ``part of the opposition.'' On Sunday, White House officials were all over talk shows urging other news organizations to boycott Fox and not pick up any of its stories. Those stories, for example, would include the video that two amateur filmmakers made of ACORN representatives explaining how to open a brothel. That is a story other media managed to ignore until almost a week after Congress decided to cut ACORN's funding. The President himself has not stopped blaming banks and investment houses for the financial meltdown, even as it has become clear that Congress played a huge role, too, by encouraging Americans to borrow money for houses they could not afford. The President was ``taking names'' of bondholders who resisted the General Motors and Chrysler bailouts. Insurance companies, once allies of the Obama health care proposal, have suddenly become the source of all of its problems because they pointed out--again correctly--that if Congress taxes insurance premiums and restricts coverage to those who are sicker and older, the cost of premiums for millions of Americans is likely to go up instead of down. Because of that insubordination, the President and his allies have threatened to take away the insurance companies' antitrust exemption. Even those in Congress have found ourselves in the crosshairs. The assistant Republican leader, Senator Jon Kyl of Arizona, said to ABC's George Stephanopoulos that the stimulus plan wasn't working. The White House wrote the Governor of Arizona and said: If you don't want the money, we won't send it. Senator McCain said this could be perceived as a threat to the people of Arizona. Senator Bennett of Utah, Senator Collins, Senator Hutchison and I, as well as Democratic Senators Byrd and Feingold, all have questioned the number and power of 18 new White House czars who are not confirmed by the Senate. We have suggested this is a threat to constitutional checks and balances. The White House refused to send anyone to testify at congressional hearings. Senator Bennett and I found ourselves ``called out,'' as they say, on the White House blog by the President's communications director. Even the President, in his address to Congress on health care, threatened to ``call out'' Members of Congress who disagree with him. This behavior is typical of street brawls and political campaign consultants. It is a mistake for the President of the United States and for the White House staff. If the President and his top aides treat people with different views as enemies instead of listening to what they have to say, they are likely to end up with a narrow view and a feeling that the whole world is out to get them. And, as those of us who served in the Nixon administration know, that can get you into a lot of trouble. This administration is only 10 months old. It is not too late to take a different approach, both at the White House and in Congress. And here is one opportunity: At the beginning of the year, shortly after the President's inauguration, the Republican leader, Senator McConnell, addressed the National Press Club. He proposed that he and the President work together to make Social Security solvent. Senator McConnell said he would make sure the President got more support in that effort from Republicans than President George W. Bush got from Democrats when he tried to solve the same problem. President Obama held a summit on the dangers of runaway costs of entitlements. I was invited and attended. Every expert there said making Social Security solvent is essential to our country's fiscal stability. There is still time to get that done. Or on clean energy, Republicans have put forward four ideas--build 100 nuclear plants in 20 years, electrify half our cars and trucks in 20 years, explore offshore for low-carbon natural gas and for oil, and double energy research and development for alternative fuels. The administration agrees with this on electric cars and on research and development. We may not be so far apart on offshore exploration. At his town meeting in New Orleans last week, the President said the United States would be, in his words, ``stupid'' not to use nuclear power. He is right since nuclear power produces 70 percent of our carbon-free electricity. So why don't we work together on this lower cost way to address clean energy and climate change instead of enacting a national energy tax? On health care, the White House idea of bipartisanship has been akin to that of a marksman at a State fair shooting gallery: hit one target and you win the prize. With such big Democratic majorities, the White House figures all it needs to do is unify the Democrats and pick off one or two Republicans. That strategy may win the prize but lose the country. Usually on complex issues, the President needs bipartisan support in Congress to reassure and achieve broad and lasting support in the country. In 1968, I can remember when President Johnson, then with bigger majorities in Congress than President Obama has today, arranged for the civil rights bill to be written in open sessions over several weeks in the office of the Republican leader, Everett Dirksen. Dirksen got some of the credit; Johnson got the legislation he wanted; the country went along with it. Instead of comprehensive health care that raises premiums and increases the debt, why should the White House not work with Republicans step by step to reduce health care costs and then, as we can afford it, reduce the number of Americans who do not have access to health care? The President and his Education Secretary Arne Duncan have been courageous--there is no better word for it--in advocating paying teachers more for teaching well and expanding the number of charter schools. These ideas are the Holy Grail for school reform. They are also ideas that are anathema to the labor unions who support the President. President Obama's advocacy of master teachers and charter schools could be the domestic equivalent of President Nixon going to China. I, among others, admire that advocacy and have been doing all I can to help him. Having once been there, I can understand how those in the White House feel oppressed by those with whom they disagree; how they feel besieged by some of the media. I hope the current White House occupants will understand that this is nothing new in American politics--all the way back to the days when John Adams and Thomas Jefferson exchanged insults. The only thing new is today there are multiple media outlets reporting and encouraging the insults 24 hours a day. As any veteran of the Nixon White House can attest, we have been down this road before, and it will not end well. An enemies list only denigrates the Presidency and the Republic itself. Forty years ago, Bryce Harlow would say to me: Now, Lamar, remember that our job here is to push all the merely important issues out of the White House so the President can deal with a handful of issues that are truly Presidential. Then he would slip off for a private meeting in the Capitol with Democratic leaders who controlled the Congress and usually found a way to enact the President's proposals. Most successful leaders have eventually seen the wisdom of Lord Palmerston, former Prime Minister of the United Kingdom, who said: We have no eternal allies, and we have no perpetual enemies. The British writer Edward Dicey was once introduced to President Lincoln as ``one of his enemies.'' ``I did not know I had any enemies,'' Lincoln answered. And Dicey later wrote: ``I can still feel, as I write, the grip of that great bony hand held out to me in token of friendship.'' In conclusion, here is my point. These are unusually difficult times, with plenty of forces encouraging us to disagree. Let's not start calling people out and compiling an enemies list. Let's push the street brawling out of the White House and work together on the truly Presidential issues--creating jobs, reducing health care costs, reducing the debt, creating clean energy.

Mr. ALEXANDER. I think it will. That is good.

Mr. ALEXANDER. That is a word I had not thought of. What I am seeing is some of the same signs I saw as a young man in the early stages of the Nixon administration. I am seeing those same signs in the Obama White House, and I am suggesting that going down that road leads to no good end. ``Nixifying'' is an interesting way to describe it.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, I ask unanimous consent to speak in morning business.

Mr. ALEXANDER. Mr. President, how much time is remaining on the Republican side?